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Domestic Violence

By Amy Otis, RN

Domestic Violence may impact as many as one fourth of American families according to the U.S. Department of Justice and Statistics.  Estimates suggest that at least 2 to 4 million women every year are physically abused. Six out of every ten married couples have experienced violence at some time during their marriage* (“Violence Against Women, Relevance to Medical Practitioners” JAMA 267 1992).

Only about one in 10 women victimized by a violent intimate seek medical treatment at a medical care facility.  Although only one million women seek medical treatment each year for injuries caused by husbands, ex-husbands and boyfriends, physicians only identify the injuries as resulting from battering about 4 percent of the time.  As doctors and nurses we are required by law to do so, we are even required in most states to take domestic violence recognition courses every year, or two years and still the under-reporting continues.

Income Level:

From 2001 to 2005, for nonfatal intimate partner victimization:

    * Women living in households with lower annual incomes experienced the highest average annual rates.

    * Women remained at greater risk than males within each income level.

Domestic Violence Dynamics

Battering tends to be overwhelmingly a male problem. While women can be and are often violent, the majority of cases of battering reflect male perpetrators and female victims. Men are still commonly paid higher salaries, given higher professional, educational, or social positions than their female counterparts. Due in part to these cultural perceptions; many men assume that this power includes dominance over their partners.

For many men, violence was learned at an early age. Boys learn at an early age that they are expected to have “power” and to be in control.

It is known that children who witness violence in their homes often grow up to repeat the violence.  Studies conclusively show a significant correlation between domestic abuse as a child and perpetrating abuse as an adult.

The Cycle of Violence

Violent episodes often follow a pattern in abusive relationships. It’s known in the health care community as the “cycle of violence”. Drugs and alcohol make violence worse, but they do not cause abuse. There are plenty of abusers who are sober.

The cycle begins with a once sweet abusers becoming increasingly agitated and tense. (Known as the tension-building phase). Abusers in the phase pick fights, yell, get angry easily, and in general act intimidating.  Victims often describe their lives with these men as “walking on eggshells”.  The victim will go to any extreme during this phase to please the abuser from having sex with him, to cooking his favorite food and so on.  The tension-building phase may last for hours or days.  Ultimately, at some point this phase breaks and the abuser takes out his frustrations on his partner and moves into the second phase of the cycle known as the battering or explosion phase.

This second phase, the battering phase may include: verbal threats of death and physical or sexual abuse to slapping, choking, and rape.  The severity of the abuse may lead to injuries that require medical attention from the health care community. Hopefully, this is where the abuse is recognized and or acknowledged by the victim.

The final phase is called the calm phase, previously known as the honeymoon phase. Here the abuser will repent for his behavior and often beg for forgiveness.  He may buy gifts, beg for forgiveness, and even cry to the woman about what he has done. 

This is often when the woman will seek help for her medical abuse; usually minor injuries that can be overlooked by busy health care workers.  During this phase her hope and belief is the strongest that he will change and so medical intervention is often futile, no matter how badly her face or body might be battered.

If you see these signs of physical or mental abuse in a friend, a sister, your daughter, a close neighbor it’s a good time to ask if there is abuse going on.  Most likely they will not be honest, but it’s worth the risk of asking.  She may not leave, but the information you provide her with may eventually save her life. Give her the National Domestic Violence Hotline (in the USA): 800-799-7233. Make sure she has it.

If someone is going to leave an abusive relationship they must have a plan. 

Plan how you will get away from the abuser and whom you will need to call.  Have that emergency number with you at all times.

Plan where you will go if you choose to or are forced to leave.

Plan what you will take with you.  Have a small bag packed for your “emergency exit” before hand.  Keep it somewhere he won’t see it.

Plan for children and pets.

Plan for other responsibilities and needs. ALWAYS have your own bank account and credit cards.

Keep your documents like passport, green card, address book, checkbook, etc. at work if possible.  Get a prepaid calling card so you can contact people you need to call.

* The National Domestic Violence Hotline in the USA is: 800-799-7233

* National Domestic Violence Hotline - 1-800-FYI-CALL

Know that: *57 on a touchtone phone verifies the last call into your phone to the police. This can be used for call tracing if you are leaving a violent person.

Have the phone number of a women’s shelter, or the friend you might be going to with you and your belongings.

Remember, you are loved and too precious to be a victim anymore. We wish you the best of luck in your new future.

Part II: Abusers and Abusive Traits

Abusers share many traits that are easily identifiable to the informed person with increased awareness. (That person could be you, perhaps).  Mental health issues can be a factor for some batterers.

Many batterers:

Have an inability to accept responsibility for their actions;

Blame authority figures for their problems;

Uses excuses to avoid accountability;

Have a history of antisocial behaviors beginning in adolescence or earlier;

Have substance abuse issues;

Have prior arrest records;

Have poor driving records;

Have a series of failed relationships;

Have made frequent employment changes;

Have financial problems:

Have emotional problems, from depression and suicidal ideation to mania and homicidal ideation.

Keep in mind:

Abusers are very quick to become intensely involved with a partner.  It is not uncommon to see relationships progress from dating to living together in a matter of weeks or months.  Abusers readily commit to relationships and may express feelings of love after only several dates. Abusers move from one relationship to another with little time between them.

General Statistics - In case you need to know.

    * On the average, more than three women are murdered by their husbands or boyfriends every day.1
    * 92% of women say that reducing domestic violence and sexual assault should be at the top of any formal efforts taken on behalf of women today.2
    * 1 out of 3 women around the world has been beaten, coerced into sex or otherwise abused during her lifetime.3
    * 1 in 5 female high school students report being physically and/or sexually abused by a dating partner. Abused girls are significantly more likely to get involved in other risky behaviors. They are 4 to 6 times more likely to get pregnant and 8 to 9 times more likely to have tried to commit suicide.3
    * 1 in 3 teens report knowing a friend or peer who has been hit, punched, slapped, choked or physically hurt by his/her partner.4
    * As many as 324,000 women each year experience intimate partner violence during their pregnancy. 5
    * Violence against women costs companies $72.8 million annually due to lost productivity.6
    * Ninety-four percent of the offenders in murder-suicides were male.7
    * Seventy-four percent of all murder-suicides involved an intimate partner (spouse, common-law spouse, ex-spouse, or boyfriend/girlfriend). Of these, 96 percent were females killed by their intimate partners.7
    * Most murder-suicides with three or more victims involved a "family annihilator" -- a subcategory of intimate partner murder-suicide. Family annihilators are murderers who kill not only their wives/girlfriends and children, but often-other family members as well, before killing themselves.7
    * Seventy-five percent of murder-suicides occurred in the home.7

1. Bureau of Justice Statistics Crime Data Brief, Intimate Partner Violence, 1993-2001, February 2003.
2. Progress & Perils: New Agenda for Women, Center for the Advancement of Women. June 2003.
3. Silverman, Jay G., Raj, Anita, and Clements, Karen. “Dating Violence Against Adolescent Girls and Associated Substance Use, Unhealthy Weight Control, Sexual Risk Behavior, Pregnancy, and Suicidality.” Pediatrics, August 2004.
4. Teenage Research Unlimited. Findings from study commissioned by Liz Claiborne Inc. to investigate the level of and attitudes towards dating abuse among American teenagers aged 13 to 18 [online] 2005 Feb [cited 2006 Mar 20]. Available from: URL:
5. Gazmararian JA, Petersen R, Spitz AM, Goodwin MM, Saltzman LE, Marks JS. “Violence and reproductive health; current knowledge and future research directions.” Maternal and Child Health Journal 2000; 4(2):79-84.
6. Costs of Intimate Partner Violence Against Women in the United States. 2003. Center for disease Control and Prevention, National Center for Injury Prevention and Control. Atlanta, GA/
7. Violence Policy Center (VPC), American Roulette: Murder-Suicide in the United States, April 2006.

Resources and Organizations:

1. Choose Respect

2. Office for Victims of Crime

3 . Love is Respect - National Teen Dating Abuse Helpline - 1-866-331-9474

4. Office on Violence Against Women


6. National Domestic Violence Hotline

7. National Violence Against Women Prevention Research Center



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